resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
July, 2008, Vol. 08, Issue 07
The Role of the Q Angle in Anterior Knee Pain
By Whitney Lowe, LMT
Postural distortions can lead to numerous soft-tissue disorders. Clients with these postural challenges often look to the massage therapist to help with the pain or biomechanical challenges that result.In the lower extremity, a large quadriceps angle, more commonly called the Q angle, is a postural distortion involving patellofemoral biomechanics. An exaggerated Q angle can lead to knee pain and knee pathologies, as well as compensations in other regions of the body.1
The degree of the Q angle is determined by measuring two lines superimposed on the lower extremity. One line begins at the tibial tuberosity and continues in a superior direction through the midpoint of the patella. A second line connects the anterior superior iliac spine (ASIS) with the midpoint of the patella. The angle between these two lines is the Q angle (Figure 1).
There is a disagreement in the research literature about what constitutes an exaggerated Q angle. Some sources say a Q angle as small as 10 degrees can be a problem, while others say it is not an issue until the angle is greater than 20 degrees.2 A challenge with evaluating the Q angle's role is it's not easy to accurately measure the angle. However, repeated investigations have shown people with a larger Q angle have a greater likelihood of developing numerous knee complaints.
To understand how the Q angle contributes to knee pathologies, it's helpful to look at the anatomical relationships in the region. The patella is embedded in the quadriceps tendon. There is a ridge on the underside of the patella that must fit in the trochlear groove between the two condyles of the femur (Figure 2). The patella moves superiorly and inferiorly in this groove during knee flexion and extension.
The patella's ability to track straight in the trochlear groove is determined by the quadriceps' angle of pull. When the Q angle is greater, the quadriceps pull the patella in a more lateral direction. The unequal pull on the patella causes increased tensile stress on soft tissues around the knee. Too much lateral pull on the patella also can drag it against the lateral femoral condyle and eventually cause degeneration of the cartilage on the underside of the patella - a condition known as chondromalacia patellae. Problems associated with the patella and its correct movement during flexion and extension are referred to as patellar tracking disorders. In addition to patellar tracking disorders, a larger Q angle also can be a major factor in patellar subluxation or dislocation, as well as anterior cruciate ligament sprains.
There is an increased incidence of these knee disorders in women and individuals with genu valgum. The Q angle is greater in women due to the wider pelvis, which places the ASIS farther away from the patellar midline, thereby increasing the Q angle. The Q angle also is greater in people who have the genu valgum postural distortion, more commonly known as knock-knees.
Because certain aspects of bony structure, such as a wide pelvis, determine the Q angle, it's difficult to alter the angle with soft-tissue work alone. However, treatments such as massage are helpful for addressing some of the factors that aggravate Q angle problems. For example, an imbalance in tightness between the vastus lateralis and vastus medialis muscles can contribute to patellar tracking disorders. If the vastus lateralis is too tight, it can pull the patella farther in a lateral direction. This situation often occurs in people with a larger Q angle. Comprehensive massage treatment of the vastus lateralis can reduce the distance it pulls the patella in a lateral direction.
There are numerous causes of anterior knee pain. Several of these can be related to an excessive Q angle. It's not necessary to pull out the protractor and determine the exact Q angle. However, a visual estimation of the Q angle can give important clues about the role this postural distortion plays in a variety of pain complaints. In those cases, massage treatment of the quadriceps muscle group and the retinacular fibers around the patella greatly helps reduce the detrimental results of a large Q angle.
Click here for more information about Whitney Lowe, LMT.
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